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Home My WebLink AboutGrant Related - BOCC (002)GRANT COUNTY COMMISSIONERS AGENDA MEETING REQUEST FORM (Must be submitted to the Clerk of the Board by 12:00pm on Thursday) REQUESTING DEPARTMENT: BOCC REQUEST susnnirrED BY: Karrie Stockton CONTACT PERSON ATTENDING ROUNDTABLE: Kal"1"I@ Stockton CONFIDENTIAL INFORMATION: ❑YES ® NO DATE: 9/30/2025 PHONE:2g37 ❑Agreement / Contract ❑AP Vouchers ❑Appointment / Reappointment ❑ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑Computer Related ❑County Code ❑Emergency Purchase ❑Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders *Grants — Fed/State/County ❑ Leases ❑ MOA / MOU ❑ Minutes ❑ Ordinances ❑ Out of State Travel ❑ Petty Cash ❑ Policies ❑ Proclamations ❑ Request for Purchase ❑ Resolution ❑ Recommendation ❑ Professional Serv/Consultant ❑Support Letter ❑ Surplus Req. ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB Reimbursement request from McKay Healthcare on the Strategic Infrastructure Program Project No. 2023-01, Phase 1 Architecture and Engineering Site Plan in the amount of $2,914.73. If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 0 N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION: AG " ' ZS� APPROVE: DENIED ABSTAIN D1: D2: D3: 4/23/24 gn MEMO woo DEFERRED OR CONTINUED TO- WITHDRAWN - PROJECT CERTIFICATION This form must be signed and returned, with an invoice, for the approved funding, before reimbursement can be approved by Grant County, SIP Project Proposal Number: SIP2023-01 SIP Funding Recipient McKay Hospital & Rehab SIP Project Description Phase 1 Architecture and Engineering Site Plan L the undersigned, do hereby certify under penalty of perjury, that the materials have been furnished, the services rendered, and/or the labor performed as described in the project proposal for the above -referenced SIP Project and that I am authorized to authenticate and certify to this claim. I also certify that this claim of $2,914 is just and due and is an unpaid obligation against Grant County. Further, according to the SIP Project Funding Policies,, I attest that at the next audit of my entity, this project shall be called to the attention of the Washington State Auditor's Office and an emphasis audit will be requested to assure that these funds were expended toward the project and according to the intent of the proposal. n V bal Signature Audra Gutierrez Printed Name Qo� Date gned Administrator/Sgpefintendent Title AdministratoL/Su'verintendent Printed Title Completed, signed original certification and invoice are to be mailed to: Administrative Services Coordinator, PO Box 37, Ephrata, WA 98823 0"0% Reimbursement # 30 in the amount ota f $2,914. . ATTACHMMNT 4 McKAY HEALTHCARE 672 Bureau Of Reclamation 08/13/2025 95357 Invoice Number Invoice Date Description Gross Amount Discount Taken; Net Amount Paid 90121032 08/06/2025 Admin-- PS - SIP2023-01 $2,914-73 .......... . $0.00. $2,914.73 $2,914.731 $1 124914.73 PAY TO THE ORDER OF MEMO McKAY HEALTHCARE 127 SECOND AVE SW - PO BOX 819 SOAP LAKE, WA 98851 (509) 2465-1111 Bureau Of Reclamation DOI-BOR-Region:Colurnbia Pacific NW PO Box 6200-25 Portland, OR 97228-6200 .44V op." w ........ 7 77 7 US BANK 6041 095357 96-615111232 08/13/2025 10 GOL, 109S35?11" 1: 123 20GS 161: I53 2 100 20 13411'1 DI-1040 UNITED STATES DEPARTMENT OF THE INTERIOR Pagel DOWN PAYMENT (BILL) REQUEST Bill #.- 90121032 Make Remittance Payable To: Bureau of Reclamation Customer: 3000025320 Billing Contact: Rachel Welch, CPN-4231 Phone: 208-378-5112 Date: 0810612025 Due Date.- 0910512025 Remit Payment To: DOI - BOR - Region: Columbia Pacific NW Send Overnight Mail To: PO Box 6200-25 US Bank-Attn: Government Lockbox-DOI Portland, OR 97228-6200 Lockbox # 6200-25 17650 NE Sandy Blvd. Payer: PUBLIC HEALTH DISTRICT 4 OF GRANT COUNTY Portland, OR 97230 DBA MCKA Y HEAL THCA RE C/O LUDA SHCHEBLANOVA, P.O. BOX819 SOAP LAKE WA 98851 Checks must be made payable to Pay Online Bureau of Reclamation. Please detach the top portion www.pay.govlpubliclformlstartl596136970 or include bill number on all remittances. Amount of Payment: $ Zcif q s""7?i 0 1.*** W* *4i- *44 *!* X*** 0 **W.16A At* '00**** v *w swto+d.-A _i..*0 a A frx.f� .....*.*W .,q Lit* #i.,W* f... 0***.. A 0 Date Description ------ Qty ----------- Unit Price Amount Cost Per 0810612025. Administrative costs for continued preparation of 1 2,914.73 1 Z914.73 M&I Contract Total additional funding $3, 000. 00 Less balance first installment ($85.27) Total balance owed $Z 914.73 16XX160070 Amount Due this Bill: 2914.73 Accounting Classification. Sales Order: 129275 Sales Office: BORI God:a A .. .. ..... Customer: 3000025320 Accounting * 11612083 TIN: *****7906 -,-icl Akpproval: RECEIVED AUG 11